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A decline in portrayal of tobacco use in prime-time TV dramas was associated with reductions in adult cigarette consumption.

The decline in TV tobacco portrayal was associated with nearly half the effect of increases in cigarette prices over the study period.

Tobacco use on television isn't just a potential influence on children -- adults are susceptible too, according to a long-term analysis.

As smoking was shown less on prime time TV from 1955 to 2010 -- dropping from a peak of nearly five instances per hour to 0.29 per hour at the end of the study -- adult cigarette consumption fell as well, Patrick E. Jamieson, PhD, and Daniel Romer, PhD, both of the University of Pennsylvania in Philadelphia, found.

For each fewer instance of tobacco shown per hour of prime-time programming spread over 2 years, U.S. adults averaged two fewer packs (38.5 cigarettes) smoked per year.

That finding was controlled for changes in cigarette prices and other factors, including the ban on tobacco advertising in 1971, the researchers reported online in Tobacco Control.

The decline in smoking on TV added up to a cumulative effect nearly half that from raising cigarette prices over the same period, which is considered one of the most effective anti-tobacco strategies.

"Tobacco in terms of TV is a bigger deal than we would have thought," Jamieson told MedPage Today, though he acknowledged that the observational results couldn't prove a causal link.

With Americans averaging hours in front of the TV per day, that medium might have a bigger impact than movies, for which Jamieson and Romer previously tied long-term trends in smoking portrayals to per-capita cigarette smoking among adults.

For adults, cigarette portrayals in the media are more likely to influence habits they already have, the researchers suggested.

Based on prior studies, "exposure to televised tobacco use may elicit craving in smokers that could reinforce their smoking or encourage relapse among those attempting to quit," they wrote.

For example, one prior study showed brain electrical activity indicating that cigarette-related stimuli captured the attention of smokers trying to quit. In another, smokers who watched a movie with scenes of smoking reported more cigarette cravings afterward.

The TV analysis findings may also have implications for tobacco control efforts elsewhere in the world, Jamieson and Romer noted.

"U.S. TV shows are popular internationally, and such tobacco portrayal could influence cigarette consumption beyond the USA," the researchers noted.

Their Coding of Health and Media Project (CHAMP) database counted up TV smoking portrayals in the 30 most popular prime time TV shows (excluding ads) each year from 1955 through 2010.

Only smoking by main characters and those with a speaking part that was part of the plot was included, without respect to whether the smoking was portrayed in a positive or negative light.

Characters were considered to exhibit tobacco use when they purchased, handled, or smoked a tobacco product including cigarettes, cigars, pipes, or chewing tobacco, the researchers explained. Incidents were counted as tobacco use even if the act of inhaling cigarettes or using smokeless tobacco was not shown.

Smoking portrayals on TV shows -- purchasing, handling, or smoking cigarettes, cigars, pipes, or chewing tobacco -- peaked at nearly five per hour in 1961 and then fell steadily to an average of 0.29 per hour in 2010.

Cigarette consumption nationally showed a similar trend based on CDC data, peaking at 3,597 per adult in 1963 and falling to 1,278 in 2010, and correlated well with TV portrayals (P=0.002 in the adjusted model).

Notably, instances of tobacco on TV didn't correlate with another strong predictor -- tobacco price. The two factors appeared to be "essentially independent" correlates of smoking (P=0.227 for contemporaneous analysis and P=0.158 for lagged analysis).

Rising prices of cigarettes were estimated to have contributed to a decline of 363.5 cigarettes per capita; while a decline of 179.3 was attributable to declining portrayals on prime-time television.

"Each additional cent increase in cigarette prices produced a decline of about two cigarettes per capita," the researchers noted, although they added that the two factors couldn't be directly compared.

Together the two factors likely accounted for nearly 18% of the decline in cigarette consumption since the peak in 1963, the researchers determined.

Notably, though, tobacco depictions on TV started to track less closely with per capita cigarettes after 1995, "a time when cable penetration and programming grew dramatically," the researchers noted.

The study didn't include cable shows or genres other than dramas, which have grown in popularity, they added.

The explosion in online content -- not subject to the Federal Communications Commission constraints on tobacco advertising on television -- wouldn't have been captured either.

"For decades, we've studied radio, television, film, and it's really important to move beyond that now and look at YouTube and other Internet-based sources for pro-tobacco persuasion and how to counter it," Jamieson suggested.

The study was funded by the Annenberg Public Policy Center and the Robert Wood Johnson Foundation.

The researchers disclosed no relationships with industry.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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